Survival and Prognosis of Patients with Pilocytic Astrocytoma: A Single-Center Study

Abstract

BackgroundPilocytic astrocytoma (PA) is a brain tumor that is relatively more common in children and young adults.MethodsWe retrospectively reviewed the medical records of patients with PA treated at a single center between 1988 and 2018.ResultsWe included 31 subjects with PA. The median age at diagnosis was 13.4 years, and the median follow-up duration was 9.9 years. The total PA group had a 10-year disease-specific survival (DSS) rate of 92.6% [95% confidence interval (CI), 82.6–100] and 10-year progression-free survival (PFS) rate of 52.8% (95% CI, 32.0–73.6). In patients aged <20 years, tumors were more likely to be located in sites in which gross total tumor resection (GTR) was impossible. No statistically significant difference in 10-year DSS was found between the GTR (100%) and non-GTR (89.7%; 95% CI, 76.2–100; p=0.374) groups. However, a statistically significant difference in 10-year PFS was found between the GTR (100%) and non-GTR groups (30.7%; 95% CI, 8.6–52.8; p=0.012). In the non-GTR group, no statistically significant difference in 10-year DSS was found between the patients who received immediate additional chemotherapy and/or radiotherapy (Add-Tx group, 92.9%; 95% CI, 79.4–100) and the non-Add-Tx group (83.3%; 95% CI, 53.5–100; p=0.577). No statistically significant difference in 10-year PFS was found between the Add-Tx group (28.9%; 95% CI, 1.7–56.1) and non-Add-Tx group (33.3%; 95% CI, 0–70.9; p=0.706).ConclusionThe PFS of the patients with PA in our study depended only on the degree of surgical excision associated with tumor location. This study is limited by its small number of patients and retrospective nature. A multicenter and prospective study is necessary to confirm these findings.

Adult-Onset Pilocytic Astrocytoma Predilecting Temporal Lobe: A Brief Review

“…Similarly, the role of adjuvant chemotherapy is still unclear [ 33 ]. Nevertheless, in young patients with a tumor that is inoperable or difficult to remove, chemotherapy can be of some use in delaying radiotherapy, thus preventing unwanted side effects of radiation, such as damage to the developing brain [ 34 , 35 ].…”

“…Compared to other locations, pilocytic astrocytomas located in the brainstem have a very poor prognosis, as many structures vital for life lie inside it. Difficult access and incomplete resection are other factors that determine the bad prognosis in this region [ 35 ].…”

An Overview of Central Nervous System Tumours

“…Pilocytic astrocytomas (PAs) are benign, slow growing tumours that stem from astrocytes [31]. They account for approximately 5-10% of diagnosed intracranial tumours taking into consideration all age groups [32].…”

Long-term outcome after management of pilocytic astrocytoma in the posterior fossa in a pediatric population

“…Pilocytic astrocytoma (PA) in the posterior fossa is one of the most common tumor entities in pediatric patients although the overall incidence in the whole population remains low ( Villanueva et al, 2019 , Donofrio et al, 2020 , Rickert and Paulus, 2001 ). The current standard of care for such lesions is surgery with maximal extent of resection, sometimes followed by radiotherapy in case of incomplete resection and recurrent tumor growth ( Villanueva et al, 2019 , Park et al, 2019 , Palma et al, 2004 ). Being a benign glial tumor (WHO grade I), the 5-year survival rate for PA in general is estimated to be ≈ 97% ( Segal and Karajannis, 2016 ), which is highly influenced by the extent of surgical resection ( Park et al, 2019 , Fernandez et al, 2003 ).…”

“…The current standard of care for such lesions is surgery with maximal extent of resection, sometimes followed by radiotherapy in case of incomplete resection and recurrent tumor growth ( Villanueva et al, 2019 , Park et al, 2019 , Palma et al, 2004 ). Being a benign glial tumor (WHO grade I), the 5-year survival rate for PA in general is estimated to be ≈ 97% ( Segal and Karajannis, 2016 ), which is highly influenced by the extent of surgical resection ( Park et al, 2019 , Fernandez et al, 2003 ). Symptoms leading to diagnosis such as ataxia, sensorimotor or cranial nerve (CN) deficits appear mainly due to space occupying tumor growth, while drowsiness, nausea and dizziness are oftentimes caused by obstruction of the ventricular system leading to hydrocephalus ( Salles et al, 2020 , Won et al, 2020 ).…”